Corp Services Request Form

ADDITIONAL CHECKING ACCOUNT ITEMS REQUEST FORM

Organization Name*

ACCU Member Number*

Organization EIN Number*

Primary Contact Name*

First Name

Last Name

Primary Contact Phone Number*

Primary Contact Email Address*

In order to best utilize your checking account with ACCU, we can assist your organization and order any or all of the following items for you: endorsement stamps, deposit slips, and checks.

Please select below which of these items you would like to place an order for. Each of the items you request will incur a separate charge that will be charged to your ACCU checking account.

Endorsement Stamps: approx $40-$50 per stamp

Deposit Slips: approx $45 + shipping for one box of 200 carbon copy deposit slips

Checks: price varies (may range from $15-$300 depending on size, style, etc)

ACCU Checking Account Number*

Which of the following items are you needing to order for your checking account?*

Endorsement Stamp Deposit Slips Checks

Select all that apply

Please select the number of endorsement stamps you are needing to order:*

Total for Endorsement Stamp(s): $

This is an estimated amount

Please select how many books of deposit slips you would like to order:*

One book= 200 deposit slips

Total for Deposit Slips: $

This is an estimated amount- the total cost will be this amount plus shipping

Check Order: ACCU uses a vendor called Harland Clarke to order all checks for our members. For business checks, we do recommend that our members check with other vendors for better pricing on checks.

Costco has a great selection of business checks at lower costs, and we often refer our corporate members to order their checks through Costco to save on cost.

If you would still prefer ACCU to place a check order for you through our vendor, Harland Clarke, we can work with you to configure the checks to exactly what you need.

If you would like to proceed with a check order through ACCU, please select YES below and an ACCU representative will call the primary contact listed on this form to walk through the check order options we have for your organization.

Yes, I would like an ACCU representative to call me to assist us with placing a check order No, we will explore our check ordering options through other vendors

AUTHORIZATION

I/We authorize ACCU to charge our ACCU checking account for the items requested above. We understand that once the items are ordered, they will be sent to the address on our account and may take 7-10 business days for the items to arrive.

I Agree

Authorized Signer Name*

First Name

Last Name